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首页> 外文期刊>Critical care medicine >Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure.
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Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure.

机译：细菌血症，急性生理学和慢性健康评估II和改良的终末期肝病是重症非移植性急性肝衰竭患者死亡率的独立预测因子。

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OBJECTIVES: To determine what physiological and biochemical factors predict development of bacteremia in nontransplanted patients with acute on chronic liver failure and, on diagnosis of bacteremia, what is the natural history of bacteremic patients versus control subjects (acute on chronic liver failure). INTERVENTIONS: None. DESIGN: Retrospective analysis of data collected prospectively and entered into a dedicated physiology database. SETTING: Specialist liver intensive therapy unit. PATIENTS: Critically ill non-transplanted patients with acute on chronic liver failure admitted between January 2003 and July 2005. MEASUREMENTS AND MAIN RESULTS: One hundred eighty-four patients were defined with acute on chronic liver failure; 67 (36%) had bacteremia. One hundred seventeen (64%) patients did not (acute on chronic liver failure). Fifty-eight percent of isolates were Gram-negative organisms, 36% were Gram-positives, and 6% fungemia. Median time to first bacteremia was 8 days (range, 3-12 days). On admission (univariate), bacteremic patients had significantly higher Modified End Stage Liver Disease scores (27 vs. 24, p = .037), Acute Physiology and Chronic Health Evaluation II scores (23 vs. 21, p = .049), and greater degrees of encephalopathy (Glasgow Coma Scale score 10 vs. 12, p = .001). During their liver intensive therapy unit course, bacteremic patients had significantly greater requirements for renal replacement therapy (64% vs. 49%, p = .043), mechanical ventilation (88% vs. 68%, p = .002), and a longer median liver intensive therapy unit stay (16 vs. 5 days, p < .001). Survival to hospital discharge was worse in the bacteremic group (25% vs. 56%, p < .001). Multivariate analysis (logistic regression) was performed separately modeling with Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease. In the first model, Acute Physiology and Chronic Health Evaluation II (odds ratio 1.24) and bacteremia (2.24) were independent predictors of mortality. In the later model, Modified End Stage Liver Disease (odds ratio, 1.06), requirement for renal replacement therapy (3.08), Glasgow Coma Scale (0.72), and bacteremia (2.30) were significant. Both models performed similarly (Modified End Stage Liver Disease area under the receiver operating characteristic curve, 0.864; Acute Physiology and Chronic Health Evaluation II, 0.862). CONCLUSIONS: In nontransplanted patients with acute on chronic liver failure, bacteremia was associated with increased severity of illness on admission, greater requirements for organ support, and independently adversely impacted on survival. Higher Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease scores were also independently predictive of mortality.
机译：目的：确定哪些生理和生化因素可预测非移植性慢性肝衰竭急性患者的菌血症发展，以及在诊断菌血症时，菌血症患者与对照受试者（急性肝衰竭急性患者）的自然病史是什么？干预措施：无。设计：回顾性分析前瞻性收集的数据，并将其输入专用的生理数据库。地点：专科肝脏强化治疗室。患者：2003年1月至2005年7月间收治的非移植性急性肝衰竭急性重症患者。测量和主要结果：184例急性慢性肝衰竭患者为急性。 67（36％）人患有菌血症。一百一十七（64％）例患者没有（慢性肝衰竭急性发作）。 58％的分离株为革兰氏阴性菌，36％为革兰氏阳性菌，6％为真菌病。首次菌血症的中位时间为8天（范围3-12天）。入院时（单变量），细菌菌群患者的改良终末期肝病评分（27 vs. 24，p = .037），急性生理和慢性健康评估II评分（23 vs. 21，p = .049）显着更高。更大程度的脑病（格拉斯哥昏迷量表评分10与12，p = 0.001）。在他们的肝脏强化治疗单元课程中，细菌患者对肾脏替代疗法（64％vs. 49％，p = .043），机械通气（88％vs. 68％，p = .002）的需求明显增加。肝脏强化治疗中位时间更长（16天比5天，p <.001）。细菌组的出院生存率较差（25％vs. 56％，p <.001）。分别使用急性生理学和慢性健康评估II和改良的终末期肝病分别进行多变量分析（逻辑回归）建模。在第一个模型中，急性生理和慢性健康评估II（优势比1.24）和菌血症（2.24）是死亡率的独立预测因子。在后来的模型中，改良的终末期肝病（比值比为1.06），肾脏替代疗法的需求量（3.08），格拉斯哥昏迷量表（0.72）和菌血症（2.30）是显着的。两种模型的表现相似（接受者操作特征曲线下的改良终末期肝病面积0.864;急性生理学和慢性健康评估II，0.862）。结论：在患有慢性肝功能衰竭急性期的非移植患者中，菌血症与入院时疾病的严重程度增加，器官支持需求增加有关，并独立地影响生存。较高的急性生理和慢性健康评估II和改良的终末期肝病评分也可以独立预测死亡率。

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